Citation

This profile was prepared when Santiago Ocejo Torres was elected to the Ashoka Fellowship in 2016.

The New Idea

Santiago has developed the first integrated system for primary health in Mexico, focusing specially on patients with chronic diseases. Santiago’s goal is to make patients healthy citizens through an integrated approach of innovation in service, financing and technology, and offer an entry point into the existing health systems that puts the patient's interest first.

Santiago's model is based on integrating all primary health needs in order to reduce time and costs for patients and incentivize self-care. Salud Cercana has developed a “bundled” service that offers its clients unlimited consultations at its clinics, which are staffed by professional doctors and in no way tied to the sale of medicines; a microinsurance option for different diseases or accidents; and access to a health coordinator, a person that will help any patient, via face to face meetings or the app, to stick to their care plan, follow up on doctor's orders, and resolve issues. Santiago is building a network of health providers in the country, so that if a patient needs secondary or specialized care or consultations, they will be able to quickly identify doctors, clinics, labs and pharmacies, and see how other users rated them. Santiago understands that the strategic use of technology can reduce costs and time for patients and doctors, so he has developed an app where patients benefit from many features such as discounts, communication channels with other patients and doctors, maps, a rate system for health practitioners and services and an emergency button.

Santiago envisions Salud Cercana as a close partner to existing health services in Mexico providing low cost, high quality services that lay the path to healthy citizens.

The Problem

In Mexico, there are over 36 million people suffering from high blood pressure (hypertension). Of these, more than half lack a diagnosis. Hypertension is the leading risk factor for developing a heart attack. In a year, more than 260,000 people suffer from a heart attack, causing the death of 1 Mexican every 4 minutes. From these deaths, only 7 out of 100 people die in a hospital, the rest die at home without care. Hypertension is just one of many chronic diseases that affect millions of Mexicans with catastrophic consequences due to the lack of an efficient primary care model.

2.7 million people per month seek care in highly inefficient public attention models and 3.4 million people per month seek care in private "pharmacy doctor" models which operate under perverse incentives towards selling medicine. For the majority of patients with chronic diseases, such fragmented care is the only access point to the health system.

The primary health system in the country is flawed on various fronts: the public health system continues to focus on attending sickness and not on developing healthy habits, doctors are often undertrained and unregulated, patients do not have anyone they can direct their concerns to, there is no strategic use of technology, and the private health providers are fragmented. All these failures result in patients receiving attention that lacks supervision and training, where doctors do not provide the necessary monitoring and are illegally rewarded for the excessive prescription of medications. Additionally, 20% of what patients spend is wasted on unnecessary or duplicated medications, consultations and lab studies.

Solutions up to now have focused only on solving parts of the issue, missing the importance of an integrated approach that includes public and private partners and has the patient at its core. According to the OECD, this lack of integration and professionalism in the current health system result in late, low quality, fragmented attention and increases out of pocket expenses for patients, regardless of the efforts made by the state and the increase in public spending.

The Strategy

While studying a biomedical innovation program at Stanford focused on solving public health issues around the world, Santiago identified the obstacles that low-income patients with chronic disease in Mexico face while seeking appropriate care and realized that there was much to be done to create a proper solution. After other work experiences that helped shape what Santiago wanted to do, in 2015 he launched Salud Cercana, a coordinated health program that offers patients, especially those with chronic diseases, an integral solution to their health issues. Santiago's idea was to develop a bundle that would cover all of the patients´ needs for an affordable price, and encourage patients and health providers to become active participants in the improvement of the health system. He starts from the idea that integrated primary health services make a real difference in the welfare of patients, as they deal with the clinical, cognitive, educational, emotional and financial issues that affect them.

In 2015, Santiago opened the first Salud Cercana clinic where anyone could receive primary health consults for an affordable price (2.5 USD). This clinic is located in Ecatepec, the most populated municipality in the State of Mexico, and part of Mexico City. Ecatepec is inhabited mostly by low income families, and has a very high rate of violence, poverty and health issues. This clinic is staffed by professional doctors, who are constantly trained and offered good career plans, and in no way tied to the sale of medicines. All of this ensures that the staff provide patients with proper care. The clinic also offers health and prevention workshops that help patients better deal with their conditions.

After collecting necessary insights into patients’ needs and wants through the first clinic, Santiago started building additional offerings into the Salud Cercana bundle. Santiago developed the figure of a “health coordinator,” a person in charge of constant communication with specific groups of patients, who moderates conversations between patients and encourages them to follow their care plan, follow up on doctors’ orders, and resolve any issues. Each patient who purchases the health bundle is assigned a coordinator. The role of the coordinator is important because, as Santiago noticed, in urban populations, families are busier and fragmented and these activities -- usually performed by a family member and vital in a chronic patient's well-being --were being disregarded. In order to facilitate the communication between patients, doctors and coordinators, Santiago developed an mobile application where, apart from connecting to these other actors, users can access medical content, consult their prescriptions and doctor's notes or recommendations, access discounts on labs and drugstores, open maps where they can find health services and rate them, and even get emergency help with one click of a button. Full access to the app is granted to Salud Cercana's bundle customers, but any person can download and use it to access the content, network and maps.

Salud Cercana's bundle is offered for 7.5 USD a month, and offers unlimited consults in the clinics. Santiago has set partnerships with insurance companies to offer microinsurance options to users that can be purchased separately and can prevent catastrophic expenses. Santiago is constantly trying to drive costs down for patients. To this cause he closed a partnership deal with Laboratorios el Chopo in March 2016, a national lab studies provider that is offering special discounts to Salud Cercana's users. This is only the first of many partnerships that Santiago is building, improving the offer constantly.

Santiago understands the role of Salud Cercana as a primary health provider and an organized entry point to the existing health systems, but he knows the organization can play a vital role in the transformation of the sector. This is why, part of Salud Cercana's goal is to create a network of actors in the health field that can be listed in the app, along with their full information so that patients can make informed decisions when seeking secondary or specialized care. Historically, the health sector in Mexico, especially the public system, has not been subject to reviews, and doctors are often not supervised or regulated. Santiago envisions patients becoming active participants in demanding accountability and transparency from health providers and opening channels of communication that lay the road to this new reality.

Since its start in 2015, Salud Cercana has offered more than 600 consults to patients and has provided the bundled service to 30 clients. Santiago's focus is on improving health care so they are developing a software that will allow to easily track patient's wellbeing through key indicators such as clinical measurements of the physical condition of patients (eg, blood pressure) over time; measurements of subjective perception (eg, satisfaction with the treatment received) after consultations; economic measurements (eg, savings generated by fixed monthly payment versus isolated consultations and other expenses) to demonstrate tangible benefits; and organizational measurements (eg, perception of general practitioners and health coordinators of the work of Salud Cercana) to demonstrate a base change in the dynamics of doctors.

In June 2016 Santiago will open 2 more clinics and by the 1st quarter of 2017 he will have a fourth clinic, with 400 – 600 consults per month, 12 – 15 health coordinators providing service to 4,500 bundle patients and he will start developing other health bundles (for pregnancies, pediatrics or other conditions). By 2021 Santiago plans to have more than 100 health providers in the network, including the public sector, and by 2027 he will have national presence and start international scaling.
In order to scale this quickly Santiago is partnering with organizations such as ProMujer (a national MFI) which will purchase Salud Cercana's bundle as a benefit for their clients. ProMujer 's branch in Ecatepec is already on board and will start providing the benefit to 4,000 clients in 2016.

The Person

Santiago´s passion for the world of medicine was his entry point into public health innovation. Medicine was the way he thought he could best serve people and improve lives in Mexico. He studied medicine at the Technological Institute of Monterrey, but very shortly after graduating, he realized that his real interests lay in the manners in which technology, innovation, private sector social impact solutions and medicine can combine to create a more healthy citizenry. He started to gain a broader view of holistic health, and he began collaborating on several health start ups in some capacity, learning best and worst practices that he would later be useful in the launching and directing of his own initiative, Salud Cercana.

In addition to health initiatives, Santiago gained experience in Pro Mujer, a microfinance institution as the Director of Health and Human services, learning by example how a social business model can help solve the most difficult societal problems. In 2009, he decided to study a Masters of Public Health at Harvard University. Both during this time at Harvard, as well as at a Stanford biomedical innovation program, Santiago became increasingly interested in technology based, scalable innovations within the health sector, and he found his interest in facilitating access to quality medical services.

After his Public health degree and microfinance experience, Santiago decided to study his Masters of Business Administration at Harvard Business School to be able to fully integrate his passions, skills, and trainings into creating new, innovative models to improve health in Mexico and Latin America. After finishing his studies, he moved back to Mexico and was able to combine this health and business expertise and experiences to launch Salud Cercana in early 2015.